Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | DE | |
N | 2251E1200X | Ergonomics | DE | |
N | 225XE1200X | Ergonomics | DE | |
N | 2251G0304X | Physical Therapist - Geriatrics | DE | |
N | 2251X0800X | Physical Therapist - Orthopedic | DE |
NPI | 1619452745 |
---|---|
Provider Name | Dr. Raymond Facciolo JR. |
First Address | Wilmington, DE 19808-4333 |
Second Address | Wilmington, DE 19897-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2018 |
Last Update Date | 25/09/2018 |